Hand-Held Dynamometry to Safely Measure Muscle Strength in Patients In Intensive Care

Abstract Background: Intensive care unit-acquired weakness (ICU-AW) has been increasingly studied and associated with prognostic factors of negative outcomes during the hospitalization of critically ill patients. Therefore, it is essential to evaluate the muscle strength of patients in the intensive care unit (ICU) with accurate quantitative tools, such as the hand-held dynamometer (HHD), which directly measures the strength of large muscle groups, providing earlier and more accurate decision making. The objective of the present study was to evaluate the safety of using HHD to measure the strength of large muscle groups in ICU patients, in addition to determining the prevalence of muscle imbalance in these patients, and correlating HHD measures with the Medical Research Council (MRC) scale. Methods: A cross-sectional study was conducted, inferring the impact of strength measurement of the main muscle groups using HHD on vital signs, dyspnea, and pain. The occurrence of adverse events during the evaluation was also observed. Safety was assessed using the paired t-test, calculating the prevalence of muscle imbalance in the sample and Pearson’s correlation between the strength measurement instruments. Results: The sample consisted of 46 volunteers, and no clinically significant variability was observed for pre- and post-safety variables. A high prevalence of muscle imbalance was found in the sample, and there was a strong correlation between HHD and MRC. Discussion: Strength measurement using HHD in the ICU is safe and well-tolerated, providing information on the individual condition of large muscle groups and improving the ability to diagnose muscle imbalance in the ICU patients.

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Impact of sound levels and patient-related factors on sleep of patients in the intensive care unit: a cross-sectional cohort study

Scientific Reports ◽

10.1038/s41598-020-76314-9 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Piotr F. Czempik ◽

Agnieszka Jarosińska ◽

Krystyna Machlowska ◽

Michał P. Pluta

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Sleep Quality ◽

Sleep Duration ◽

Smartphone Application ◽

Sound Level ◽

Related Factors ◽

Cross Sectional ◽

Sound Levels ◽

The Impact

Abstract Sleep disruption is common in patients in the intensive care unit (ICU). The aim of the study was to measure sound levels during sleep-protected time in the ICU, determine sources of sound, assess the impact of sound levels and patient-related factors on duration and quality of patients' sleep. The study was performed between 2018 and 2019. A commercially available smartphone application was used to measure ambient sound levels. Sleep duration was measured using the Patient's Sleep Behaviour Observational Tool. Sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ). The study population comprised 18 (58%) men and 13 (42%) women. There were numerous sources of sound. The median duration of sleep was 5 (IQR 3.5–5.7) hours. The median score on the RCSQ was 49 (IQR 28–71) out of 100 points. Sound levels were negatively correlated with sleep duration. The cut-off peak sound level, above which sleep duration was shorter than mean sleep duration in the cohort, was 57.9 dB. Simple smartphone applications can be useful to estimate sound levels in the ICU. There are numerous sources of sound in the ICU. Individual units should identify and eliminate their own sources of sound. Sources of sound producing peak sound levels above 57.9 dB may lead to shorter sleep and should be eliminated from the ICU environment. The sound levels had no effect on sleep quality.

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Volitional rehabilitative assessments in patients admitted in a post-intensive care step down unit. A feasibility study

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2017.764 ◽

2017 ◽

Vol 87 (1) ◽

Author(s):

Mara Paneroni ◽

Francesco D' Abrosca ◽

Georges Fokom ◽

Laura Comini ◽

Michele Vitacca

Keyword(s):

Intensive Care ◽

Muscle Strength ◽

Outcome Measures ◽

Quadriceps Muscle ◽

Disability Score ◽

Icu Patients ◽

Motor Disability ◽

Peripheral Muscle ◽

Teres Major ◽

Step Down

A high variability in functional tests and activities used during the pulmonary rehabilitation has been observed in post-intensive care unit (ICU) patients, and the best battery of tests to adopt has not been described yet. We tested in patients admitted in a post-ICU Step Down Unit the ability to perform the more frequent functional volitional tests. The relations of each single volitional test with general disability and dyspnea at discharge were also evaluated. Ten volitional tests including: bedside spirometry test (ST: FEV1%, FVC%), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), Peak Expiratory Flow during Cough (PCEF), Quadriceps Muscle Strength (QMS), latissimus Dorsi and teres Major Strength (DMS), Brachial biceps Muscle Strength (BMS), effort tolerance measured by sit-to-stand test, Takahashi test and 6-Min Walking Test (6MWT), were evaluated in post-ICU patients at entry and discharge from in-hospital rehabilitation. General disability was assessed by Barthel Index, while dyspnea by Borg scale. At admission, >70% of subjects performed muscle strength test, while <25% performed respiratory and effort tolerance tests. At discharge, feasibility of spirometry, respiratory muscle strength and effort tolerance tests improved (all, p<0.001); 6MWT was the least feasible. At discharge, cardiorespiratory patients were more capable to perform tests compared to neurological ones. All outcome measures, with exception of FEV1%, and FVC%, were significantly related to the disability score. Peripheral muscle exercises showed the highest feasibility, spirometry and leg effort tolerance the lowest. Motor disability was explained mainly by the peripheral muscle strength. The study of non-volitional outcome measures and tests linked to a protocol-driven intervention should be performed in this specific population.

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Nosocomial infections in a pediatric surgical intensive care unit: An unicentric cross-sectional study

Medicinski pregled ◽

10.2298/mpns2104112p ◽

2021 ◽

Vol 74 (3-4) ◽

pp. 112-116

Author(s):

Marina Pandurov ◽

Izabella Fabri-Galambos ◽

Andjela Opancina ◽

Anna Uram-Benka ◽

Goran Rakic ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nosocomial Infections ◽

Hospital Length Of Stay ◽

Surgical Intensive Care Unit ◽

Negative Consequences ◽

Surgical Intensive Care ◽

Acinetobacter Baumanii ◽

Cross Sectional ◽

The Impact

Introduction. Nosocomial infections are a common complication in patients hospitalized in intensive care units. The aims of this research were to examine the incidence of nosocomial infections in patients admitted to the pediatric surgical intensive care unit, the impact of hospital length of stay and type of surgical disease on the incidence of nosocomial infections, the frequency of microorganisms causing nosocomial infections and their antibiotic susceptibility profile. Material and Methods. Data on 50 subjects were extracted from the database. The following data were taken from the medical histories of the examinees: age, sex, diagnosis, number of days at the hospital before admission to the intensive care unit, number of days in the intensive care unit, levels of C-reactive protein, applied antimicrobial drugs, isolated microorganisms and their susceptibility to antibiotics. Results. The incidence of nosocomial infections in the study period was 52%. Patients who developed nosocomial infection remained longer in the intensive care unit than those who did not develop it (p = 0.003). Patients with the diagnosis of acute abdomen had a statistically significantly higher incidence of nosocomial infections compared to other patients (p = 0.001). Gram-negative bacteria were the most commonly isolated pathogens (46.8%). Acinetobacter baumanii proved to be the most resistant species in this study, since 80% of the strains did not show sensitivity to any of the tested antibiotics. Conclusion. Nosocomial infections are present in slightly more than half of the patients treated at the pediatric surgical intensive care unit. Patients who developed nosocomial infections stayed longer in the pediatric surgical intensive care unit, which had negative consequences for their health and treatment costs.

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Composite Uremic Load and Physical Performance in Hemodialysis Patients: A Cross-Sectional Study

Toxins ◽

10.3390/toxins12020135 ◽

2020 ◽

Vol 12 (2) ◽

pp. 135

Author(s):

Karsten Vanden Wyngaert ◽

Amaryllis H. Van Craenenbroeck ◽

Els Holvoet ◽

Patrick Calders ◽

Wim Van Biesen ◽

...

Keyword(s):

Muscle Strength ◽

Exercise Capacity ◽

Physical Performance ◽

Ridge Regression ◽

Handgrip Strength ◽

Cross Sectional Study ◽

Uremic Toxins ◽

Sectional Study ◽

Cross Sectional ◽

The Impact

Impaired physical performance is common in patients on hemodialysis (HD) and is associated with poor prognosis. A patient relevant marker of adequacy of dialysis is lacking. Previous studies evaluated uremic toxicity by assessing the impact of different uremic toxins separately. However, such an approach is most likely not reflective of true uremic toxicity. Therefore, this cross-sectional study aimed to examine if the uremic syndrome, estimated as one composite of different uremic toxins (facilitated by ridge regression method) to reflect the kinetic behavior during dialysis, is associated with physical performance in patients on HD. Levels of p-cresyl glucuronide and sulfate, indole-acetic acid, indoxyl sulfate, uric acid, hippuric acid, and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid were assessed and associated by ridge regression to muscle strength, functional exercise capacity, and measures of balance and coordination. 75 HD patients were included (mean age 68 years, 57% male). The composite of different uremic toxins (i.e., uremic load) explained 22% of the variance in handgrip strength. Although there was an association between full body muscle strength and the composite uremic load independent of nutritional status, age and gender, the predictive power of composite uremic load for muscle weakness is limited. Single uremic toxins as well as composite uremic load were not associated with exercise capacity, coordination, and balance, indicating that the degree of uremia does not predict physical performance in patients on HD.

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Upper Extremity Strength Measurement for Children With Cerebral Palsy: A Systematic Review of Available Instruments

Physical Therapy ◽

10.2522/ptj.20130166 ◽

2014 ◽

Vol 94 (5) ◽

pp. 609-622 ◽

Cited By ~ 22

Author(s):

Koen J.F.M. Dekkers ◽

Eugene A.A. Rameckers ◽

Rob J.E.M. Smeets ◽

Yvonne J.M. Janssen-Potten

Keyword(s):

Cerebral Palsy ◽

Muscle Strength ◽

Upper Extremity ◽

Upper Limb ◽

Measurement Instruments ◽

Strength Measurement ◽

Level Of Evidence ◽

Best Evidence Synthesis ◽

Children With Cerebral Palsy

Background In order to make inferences about strength related to development or treatment interventions, it is important to use measurement instruments that have sound clinimetric properties. Purpose The objective of this review is to systematically evaluate the level of evidence of the clinimetric properties of instruments for measuring upper extremity muscle strength at the “body functions & structures” level of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) for children with cerebral palsy (CP). Data Sources A systematic search of the PubMed, EMBASE, OTseeker, CINAHL, PEDro, and MEDLINE databases up to November 2012 was performed. Study Selection Two independent raters identified and examined studies that reported the use of upper extremity strength measurement instruments and methods for children and adolescents with CP aged 0 to 18 years. Data Extraction The COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist with 4-point rating scale was used by 2 independent raters to evaluate the methodological quality of the included studies. Best evidence synthesis was performed using COSMIN outcomes and the quality of the clinimetric properties. Data Synthesis Six different measurement instruments or methods were identified. Test-retest, interrater, and intrarater reliability were investigated. Two test-retest reliability studies were rated as “fair” for the level of evidence. All other studies were rated as “unknown” for the level of evidence. Limitations The paucity of literature describing clinimetric properties, especially other than reliability, of upper limb strength measurement instruments for children with CP was a limitation of the study. Conclusions For measuring grip strength, the Jamar dynamometer is recommended. For other muscle groups, handheld dynamometry is recommended. Manual muscle testing (MMT) can be used in case of limited (below MMT grade 4) wrist strength or for total upper limb muscle strength. Based on lacking information regarding other clinimetric properties, caution is advised regarding interpretation of the results.

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Glucose Disturbances and Atypical Antipsychotic Use in the Intensive Care Unit

Journal of Pharmacy Practice ◽

10.1177/0897190015579452 ◽

2016 ◽

Vol 29 (6) ◽

pp. 534-538 ◽

Cited By ~ 3

Author(s):

Amy Bishara ◽

Stephanie V. Phan ◽

Henry N. Young ◽

T. Vivian Liao

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Patient Outcomes ◽

Atypical Antipsychotic ◽

Atypical Antipsychotics ◽

Apache Ii Score ◽

Icu Patients ◽

Acute Hyperglycemia ◽

The Impact ◽

Chronic Use

Purpose: Chronic use of atypical antipsychotics may lead to metabolic abnormalities including hyperglycemia. Although evidence supports acute hyperglycemic episodes associated with atypical antipsychotic use, the acute use of atypical antipsychotics in the intensive care unit (ICU) setting has not been studied. The purpose of this study is to evaluate the occurrence of hyperglycemia in ICU patients receiving newly prescribed atypical antipsychotic. Summary: Of the 273 patient charts reviewed, 50 patients were included in this study. Approximately 45% of patients experienced at least 1 hyperglycemic episode (blood glucose >180 mg/dL) after the initiation of an atypical antipsychotic in the ICU. Of the patients experiencing at least 1 hyperglycemic episode, 60% experienced multiple distinct hyperglycemic episodes. In this study, quetiapine was the most commonly used atypical antipsychotic, 19 (38%) patients were discharged from the ICU on the atypical antipsychotic, 6 (12%) patients died in the ICU, and 31 (62%) patients were treated with an antihyperglycemic agent. Logistic regression analysis showed that women and ICU patients with a higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score were significantly more likely to have multiple hyperglycemic episodes. Conclusion: Patients admitted to the ICU and initiated on an atypical antipsychotic may develop hyperglycemia independent of other glucose-elevating factors. The direct correlation of these agents to resulting acute hyperglycemia is unknown. Further studies are needed to investigate the link between atypical antipsychotics and acute hyperglycemia and the clinical significance of the impact on patient outcomes.

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Pharmacotherapeutic follow-up in a respiratory intensive care unit: description and analysis of results

Einstein (São Paulo) ◽

10.1590/s1679-45082018ao4112 ◽

2018 ◽

Vol 16 (2) ◽

Author(s):

Ana Carolina de Souza e Silva ◽

Domingos Sávio de Carvalho Sousa ◽

Eunice Bobô de Carvalho Perraud ◽

Fátima Rosane de Almeida Oliveira ◽

Bruna Cristina Cardoso Martins

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Pharmacist ◽

Anatomical Therapeutic Chemical ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Cross Sectional ◽

Respiratory Intensive Care Unit ◽

The Impact

ABSTRACT Objective: To describe and evaluate the pharmacotherapeutic follow-up by a clinical pharmacist in an intensive care unit. Methods: A descriptive and cross-sectional study carried out from August to October 2016. The data were collected through a form, and pharmacotherapeutic follow-up conducted by a clinical pharmacist at the respiratory intensive care unit of a tertiary hospital. The problems recorded in the prescriptions were quantified, classified and evaluated according to severity; the recommendations made by the pharmacist were analyzed considering the impact on pharmacotherapy. The medications involved in the problems were classified according to the Anatomical Therapeutic Chemical Classification System. Results: Forty-six patients were followed up and 192 pharmacotherapy-related problems were registered. The most prevalent problems were missing information on the prescription (33.16%), and those with minor severity (37.5%). Of the recommendations made to optimize pharmacotherapy, 92.7% were accepted, particularly those on inclusion of infusion time (16.67%), and dose appropriateness (13.02%), with greater impact on toxicity (53.6%). Antimicrobials, in general, for systemic use were drug class most often related to problems in pharmacotherapy (53%). Conclusion: Pharmacotherapeutic follow-up conducted by a pharmacist in a respiratory intensive care unit was able to detect problems in drug therapy and to make clinically relevant recommendations.

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A cross-sectional study of muscle strength and mass in 45- to 78-yr-old men and women

Journal of Applied Physiology ◽

10.1152/jappl.1991.71.2.644 ◽

1991 ◽

Vol 71 (2) ◽

pp. 644-650 ◽

Cited By ~ 611

Author(s):

W. R. Frontera ◽

V. A. Hughes ◽

K. J. Lutz ◽

W. J. Evans

Keyword(s):

Muscle Strength ◽

Peak Torque ◽

Cross Sectional Study ◽

Fat Free Mass ◽

Knee Extensors ◽

Cross Sectional ◽

Men And Women ◽

Age Related ◽

Muscle Groups ◽

Old Men

The isokinetic strength of the elbow and knee extensors and flexors was measured in 200 healthy 45- to 78-yr-old men and women to examine the relationship between muscle strength, age, and body composition. Peak torque was measured at 60 and 240 degrees/s in the knee and at 60 and 180 degrees/s in the elbow by use of a Cybex II isokinetic dynamometer. Fat-free mass (FFM) was estimated by hydrostatic weighing in all subjects, and muscle mass (MM) was determined in 141 subjects from urinary creatinine excretion. FFM and MM were significantly lower (P less than 0.001) in the oldest group. Strength of all muscle groups at both testing speeds was significantly (P less than 0.006) lower (range 15.5–26.7%) in the 65- to 78- than in the 45- to 54-yr-old men and women. When strength was adjusted for FFM or MM, the age-related differences were not significant in all muscle groups except the knee extensors tested at 240 degrees/s. Absolute strength of the women ranged from 42.2 to 62.8% that of men. When strength was expressed per kilogram of MM, these gender differences were smaller and/or not present. These data suggest that MM is a major determinant of the age- and gender-related differences in skeletal muscle strength. Furthermore, this finding is, to a large extent, independent of muscle location (upper vs. lower extremities) and function (extension vs. flexion).

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Clock Genes Disruption in the Intensive Care Unit

Journal of Intensive Care Medicine ◽

10.1177/0885066619876572 ◽

2019 ◽

Vol 35 (12) ◽

pp. 1497-1504

Author(s):

Elena Diaz ◽

Irene Diaz ◽

Cecilia del Busto ◽

Dolores Escudero ◽

Silvia Pérez

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mrna Expression ◽

Clock Gene ◽

Clock Genes ◽

Biological Clock ◽

Icu Patients ◽

Time Points ◽

Icu Stay ◽

The Impact

Background: Intensive care unit (ICU) environment disrupts the circadian rhythms due to environmental and other nonphotic synchronizers. The main purpose of this article is to establish whether critically patients have desynchronization at the molecular level after 1 week of stay in the ICU. Methods: The rhythm of Clock, Bmal1, Cry1, and Per2 genes in neuro-ICU patients (n = 11) on the first day after admission in the unit (1 day) and 1 week later (1 week) was studied, 4 time points throughout the day, at 6, 12, 18, and 24 hours. Human whole blood samples were obtained from neuro-ICU patients. The total RNA was isolated and each sample was reverse transcribed to complementary DNA and quantitative polymerase chain reaction (PCRq) was performed. The possible rhythm was studied using Fourier Series. Results: After 1 week, the clock gene rhythmicity completely disappeared. Messenger RNA (mRNA) expression for the 4 clock genes was shown rhythmicity at the first day after admission in the ICU. Circadian rhythmicity for none of them was observed but rather, ultradian rhythmicity was found. The expression of Clock, Bmal1, and Per2 mRNA after 1 week was similar in the 4-time point studies without significant fluctuation among the 4 time points analyzed. Discussion: Rhythmic mRNA expression is present at the first day after admission in the ICU. However, ICU stay during 1 week affects the molecular machinery of the biological clock generating chronodisruption. Circadian disruption is associated with the risk of several pathologies, thus, it seems to be clear that ICU stay in constant conditions could adversely affect patient evolution and probably, circadian resynchronization restoring clock gene expression could lead to a better clinical evolution of the patient. Conclusions: Clock genes disruption is observed in neuro-ICU patients. Light therapy as well as melatonin treatment could reduce the impact of ICU stay period in biological clock, thereby improving patients’ recovery.

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